11.4 Factors associated with pain perception
11.4.3 Patients' pain perception according to
A further analysis based on mode of Renal Replacement Therapy was applied, in order to explore any differences present. No correlation was found between modes of Renal Replacement Therapy and employment (p=.755), education level (p=.553) or grouped time on dialysis (p=.720) (Figure 11).
Table 20. Correlation of renal patients’ perception of pain self-management and age in decades (n=700)
On the Wong-Baker Faces pain rating scales the absence of pain (0, “no hurt”) was stated only by five patients interviewed who were on haemodialysis. Two hundred and nine of the total seven hundred patients (34.1%) stated that they “hurt a bit more” (4) representing 80.3%
(n=192) of haemodialysis and 19.7% (n=47) peritoneal dialysis patients. The second larger group of patients (30.4%, n=213) described their pain as “hurts even more” (6) reflecting, again, mostly haemodialysis patients (82.6%, n=176) (Table 21). Chi-squared analysis found no statistical significant correlation regarding Renal Replacement Therapy (p=.540).
On the next pain measurement tool (Visual Analogue Scales) a mean pain of 5.8 (±1.8) cm (moderate pain) was recorded, as it was mentioned earlier, analysed as 5.8 (±1.9) cm for HD and at 5.7 (±1.7) cm for PD patients. Mann-Whitney U test was applied, as the distribution of the variable was not normal, and no statistical significance was found between the two modes of RRT (p=.311).
Then the analysis of the McGill Pain Questionnaire followed. In Present Pain Intensity (PPI), as it can be seen in the following table, haemodialysis treatment, as described by the participants, caused higher levels of pain, but not statistical significant (t=.527, df=698, p=.598) (Table 22).
Figure 11. Renal patients’ time on dialysis based on Renal Replacement Therapy (p=.720) (HD=haemodialysis, PD=peritoneal dialysis) (n=700).
Table 21. Renal patients’ perception of pain on Wong-Baker scales according to Renal Replacement Therapy (RRT) (n=700).
Wong-Baker Pain Scales RRT TOTAL
(%, n)
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
When pain of internal origin and external forces were correlated with age, again a statistical significance was revealed (p<.001). During the analysis of the McGill Pain Questionnaire it was found that Present Pain Intensity and Pain Rating Index showed statistical significance (p=.038 and p=.039, respectively).
Finally, in a correlation of age, grouped in decades, and methods of self-management of pain, it was found that consuming analgesics, massaging and applying warmth in the affected area was statistically significant (p<.001, p=.017 and p=.006, respectively) compared to other means of pain relief (Table 20).
11.4.3. Patients’ pain perception according to Renal Replacement Therapy
A further analysis based on mode of Renal Replacement Therapy was applied, in order to explore any differences present. No correlation was found between modes of Renal Replacement Therapy and employment (p=.755), education level (p=.553) or grouped time on dialysis (p=.720) (Figure 11).
Table 20. Correlation of renal patients’ perception of pain self-management and age in decades (n=700)
On the Wong-Baker Faces pain rating scales the absence of pain (0, “no hurt”) was stated only by five patients interviewed who were on haemodialysis. Two hundred and nine of the total seven hundred patients (34.1%) stated that they “hurt a bit more” (4) representing 80.3%
(n=192) of haemodialysis and 19.7% (n=47) peritoneal dialysis patients. The second larger group of patients (30.4%, n=213) described their pain as “hurts even more” (6) reflecting, again, mostly haemodialysis patients (82.6%, n=176) (Table 21). Chi-squared analysis found no statistical significant correlation regarding Renal Replacement Therapy (p=.540).
On the next pain measurement tool (Visual Analogue Scales) a mean pain of 5.8 (±1.8) cm (moderate pain) was recorded, as it was mentioned earlier, analysed as 5.8 (±1.9) cm for HD and at 5.7 (±1.7) cm for PD patients. Mann-Whitney U test was applied, as the distribution of the variable was not normal, and no statistical significance was found between the two modes of RRT (p=.311).
Then the analysis of the McGill Pain Questionnaire followed. In Present Pain Intensity (PPI), as it can be seen in the following table, haemodialysis treatment, as described by the participants, caused higher levels of pain, but not statistical significant (t=.527, df=698, p=.598) (Table 22).
Figure 11. Renal patients’ time on dialysis based on Renal Replacement Therapy (p=.720) (HD=haemodialysis, PD=peritoneal dialysis) (n=700).
Table 21. Renal patients’ perception of pain on Wong-Baker scales according to Renal Replacement Therapy (RRT) (n=700).
Wong-Baker Pain Scales RRT TOTAL
(%, n)
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
The mean scores for Pain Rating Index (PRI) were calculated. As in the previous pain measurement scale, haemodialysis seemed to cause increased levels of pain. The score ranged from 16 to 76, whereas in peritoneal dialysis the minimum score was set at 22 and the maximum at 68 (Table 23). Mean scores in both modes of Renal Replacement Therapy were correlated and a statistical significance was found (t = 5.452, df = 237, p<.001), as well as in fifteen out of twenty categories, separately (except pain 4, 11, 12, 15, 19) (Appendix, Table 2).
When the participants was asked to report the most painful area in their body, lower and upper extremities were reported by both groups of patients, with haemodialysis patients suffering more. Only peritoneal dialysis patients reported pain in the abdomen, diaphragm and groin (Table 24).
Table 22. Renal patients’ perception of Present Pain Intensity (PPI) by Renal Replacement Therapy (RRT) (p=.598 (n=700).
Present Pain
Intensity (PPI) RRT TOTAL (%,n)
HD PD
No pain 0 0 0 (n=0)
Mild 100% (n=5) 0 (n=0) 0.71% (n=5)
Discomforting 81.9% (n=190) 18.1% (n=42) 33.14% (n=232) Distressing 82.9% (n=243) 17.1% (n=50) 41.87% (n=293) Horrible 81.3% (n=100) 18.7% (n=23) 17.57% (n=123) Excruciating 89.4% (n=42) 10.6% (n=5) 6.71% (n=47) TOTAL 82.9% (n=580) 17.1% (n=120) 100.0% (n=700) RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
Table 23. Renal patients’ mean Pain Rating Index (PRI) by Renal Replacement Therapy (RRT) (p<.001) (n=700).
PRI score
RRT
HD PD
Mean 44.53 45.44 40.13
S.D. 12.52 13.0 8.9
Median 46.0 47.0 41.0
Minimum 16.0 16.0 22.0
Maximum 76.0 76.0 68.0
N 700 580 120
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
When patients were asked to describe the body part with the higher amount of pain caused by external forces (Table 25), the vascular access (fistula, graft or central venous catheter) was stated by the haemodialysis patients. On the other hand, seventy eight out of a hundred and twenty peritoneal dialysis patients reported that they did not experience any type of pain of external origin. In x2 test a statistical significant difference was found between the two methods of RRT regarding internal (p<.001) and external (p<.001) pain.
Finalising, the correlations of variables with modes of Renal Replacement Therapies, self-management of pain were evaluated. According to 91.6% (n=641) of the participants, a short walk was the best way to forget and manage pain, with almost eight out of ten (81.9%, n=525)
Table 24. Renal patients’ perception of internal pain regarding Renal Replacement Therapy (RRT) (p<.001) (n=700).
Origin of internal pain
RRT TOTAL
HD PD
Abdomen 0 100% (n=20) 2.86% (n=20)
Arms 94.4% (n=207) 5.6% (n=12) 31.28% (n=219) Back 34.8% (n=8) 65.2% (n=15) 3.28% (n=23)
Chest 0 100% (n=4) 0.57% (n=4)
Diaphragm 0 100% (n=7) 1% (n=7)
Groin 0 100% (n=2) 0.28% (n=2)
Legs 89.2% (n=297) 10.8% (n=36) 47.57% (n=333) Shoulder 73.9% (n=68) 26.1% (n=24) 13.14% (n=92) TOTAL 82.86% (n=580) 17.14% (n=120) 700
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
Table 25. Renal patients’ perception of external pain regarding Renal Replacement Therapy (RRT) and gender (p<.001) (n=700).
Origin of external pain
RRT TOTAL
HD PD
Abdomen 0 100% (n=28) 4% (n=28)
Back 0 100% (n=7) 1% (n=7)
CVC 98.4% (n=62) 1.6% (n=1) 9% (n=63) Fistula 100% (n=435) 0 62.14% (n=435)
Graft 100% (n=83) 0 11.86% (n=83)
Groin 0 100% (n=6) 0.86% (n=6)
None 0 100% (n=78) 11.14% (n=78)
TOTAL 82.86% (n=580) 17.14% (n=120) 700
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
The mean scores for Pain Rating Index (PRI) were calculated. As in the previous pain measurement scale, haemodialysis seemed to cause increased levels of pain. The score ranged from 16 to 76, whereas in peritoneal dialysis the minimum score was set at 22 and the maximum at 68 (Table 23). Mean scores in both modes of Renal Replacement Therapy were correlated and a statistical significance was found (t = 5.452, df = 237, p<.001), as well as in fifteen out of twenty categories, separately (except pain 4, 11, 12, 15, 19) (Appendix, Table 2).
When the participants was asked to report the most painful area in their body, lower and upper extremities were reported by both groups of patients, with haemodialysis patients suffering more. Only peritoneal dialysis patients reported pain in the abdomen, diaphragm and groin (Table 24).
Table 22. Renal patients’ perception of Present Pain Intensity (PPI) by Renal Replacement Therapy (RRT) (p=.598 (n=700).
Present Pain
Intensity (PPI) RRT TOTAL (%,n)
HD PD
No pain 0 0 0 (n=0)
Mild 100% (n=5) 0 (n=0) 0.71% (n=5)
Discomforting 81.9% (n=190) 18.1% (n=42) 33.14% (n=232) Distressing 82.9% (n=243) 17.1% (n=50) 41.87% (n=293) Horrible 81.3% (n=100) 18.7% (n=23) 17.57% (n=123) Excruciating 89.4% (n=42) 10.6% (n=5) 6.71% (n=47) TOTAL 82.9% (n=580) 17.1% (n=120) 100.0% (n=700) RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
Table 23. Renal patients’ mean Pain Rating Index (PRI) by Renal Replacement Therapy (RRT) (p<.001) (n=700).
PRI score
RRT
HD PD
Mean 44.53 45.44 40.13
S.D. 12.52 13.0 8.9
Median 46.0 47.0 41.0
Minimum 16.0 16.0 22.0
Maximum 76.0 76.0 68.0
N 700 580 120
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
When patients were asked to describe the body part with the higher amount of pain caused by external forces (Table 25), the vascular access (fistula, graft or central venous catheter) was stated by the haemodialysis patients. On the other hand, seventy eight out of a hundred and twenty peritoneal dialysis patients reported that they did not experience any type of pain of external origin. In x2 test a statistical significant difference was found between the two methods of RRT regarding internal (p<.001) and external (p<.001) pain.
Finalising, the correlations of variables with modes of Renal Replacement Therapies, self-management of pain were evaluated. According to 91.6% (n=641) of the participants, a short walk was the best way to forget and manage pain, with almost eight out of ten (81.9%, n=525)
Table 24. Renal patients’ perception of internal pain regarding Renal Replacement Therapy (RRT) (p<.001) (n=700).
Origin of internal pain
RRT TOTAL
HD PD
Abdomen 0 100% (n=20) 2.86% (n=20)
Arms 94.4% (n=207) 5.6% (n=12) 31.28% (n=219) Back 34.8% (n=8) 65.2% (n=15) 3.28% (n=23)
Chest 0 100% (n=4) 0.57% (n=4)
Diaphragm 0 100% (n=7) 1% (n=7)
Groin 0 100% (n=2) 0.28% (n=2)
Legs 89.2% (n=297) 10.8% (n=36) 47.57% (n=333) Shoulder 73.9% (n=68) 26.1% (n=24) 13.14% (n=92) TOTAL 82.86% (n=580) 17.14% (n=120) 700
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
Table 25. Renal patients’ perception of external pain regarding Renal Replacement Therapy (RRT) and gender (p<.001) (n=700).
Origin of external pain
RRT TOTAL
HD PD
Abdomen 0 100% (n=28) 4% (n=28)
Back 0 100% (n=7) 1% (n=7)
CVC 98.4% (n=62) 1.6% (n=1) 9% (n=63) Fistula 100% (n=435) 0 62.14% (n=435)
Graft 100% (n=83) 0 11.86% (n=83)
Groin 0 100% (n=6) 0.86% (n=6)
None 0 100% (n=78) 11.14% (n=78)
TOTAL 82.86% (n=580) 17.14% (n=120) 700
RRT = Renal Replacement Therapy, HD = Haemodialysis, PD = Peritoneal Dialysis
being on haemodialysis. The use of warmth on the affected area was proven to be effective for the 90.4% (n=633) of the participants, again with haemodialysis being more in favour of this method (82.8%, n=524). Exercise, either in the form of workout or yoga, was the least favourable (5.1% and 2.6%, respectively), with the majority of those patients being on haemodialysis, too (86.1%, n=31 and 66.7%, n=12, respectively). No statistical significance was found in a correlation of pain relief methods in haemodialysis and peritoneal dialysis patients. The only type of pain management that showed a statistical significance was walking (p=.027) (Table 26).